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3.
Rev. cuba. cir ; 60(2): e1010, tab
Article in Spanish | LILACS, CUMED | ID: biblio-1280221

ABSTRACT

La rehabilitación multimodal constituye un conjunto de medidas perioperatorias que sustituye prácticas tradicionales. Su implementación está fundada en criterios de medicina basada en la evidencia. El objetivo del artículo es implementar el protocolo ERAS (Enhanced Recovery After Surgery) por sus siglas en inglés, en la cirugía esofágica electiva por cáncer. Se tuvo en cuenta como documento base el protocolo ERAS del servicio. Se apoyó en la sistemática revisión de la evidencia. Se amplió la búsqueda bibliográfica en las bases de datos Biblioteca Cochrane Plus (Cochrane Library) y Medline desde el 2000 hasta 2018. Las medidas a aplicar se dividen en 3 bloques: preoperatorio, perioperatorio y postoperatorio. Su conjunto da lugar al documento de consenso que integra todas las medidas. La aplicación de protocolos de rehabilitación multimodal en cirugía esofágica reducirá la morbimortalidad postoperatoria, la estancia y los costes hospitalarios(AU)


Multimodal rehabilitation involves a set of perioperative measures that substitutes traditional practices. Its implementation is founded upon evidence-based medicine criteria. The objective of the article is to implement of the ERAS (Enhanced Recovery After Surgery) protocol for elective esophageal cancer surgery. The ERAS protocol of the service was taken into account as a base document. It was supported by systematic evidence review. The bibliographic search was broadened in the Cochrane Library and the Medline databases, from 2000 to 2018. The measures to be applied are divided into three blocks: preoperative, perioperative and postoperative. This set gives rise to the consensus document that integrates all the measures. The application of multimodal rehabilitation protocols in esophageal surgery will reduce postoperative morbidity and mortality, hospital stay and costs(AU)


Subject(s)
Humans , Esophageal Neoplasms/surgery , Indicators of Morbidity and Mortality , Evidence-Based Medicine/methods , Enhanced Recovery After Surgery , Review Literature as Topic , Databases, Bibliographic
4.
Rev. cub. inf. cienc. salud ; 32(2): e1674, 2021. tab
Article in Spanish | LILACS, CUMED | ID: biblio-1341368

ABSTRACT

El objetivo de esta investigación fue identificar las necesidades de información sobre medicamentos y salud pública en los médicos de un hospital mexicano. Se realizó un estudio descriptivo y transversal mediante una encuesta validada por expertos y por estudio piloto a 112 médicos en el año 2016. Los participantes fueron seleccionados por muestreo aleatorio simple de un hospital público de segundo nivel en Nayarit, México. Las variables estudiadas fueron: necesidades de información, comportamiento informativo y el nivel de satisfacción. El 66,4 por ciento de los médicos necesitaban información relacionada con el tratamiento farmacológico de sus pacientes y el 63,3 por ciento de los médicos tuvo necesidades sobre datos poblacionales. Las revistas médicas fueron la vía preferida para obtener información (70,4 por ciento) y al mismo tiempo obtuvieron la puntuación más alta de satisfacción. El 89,5 por ciento no consultaba bases de datos o repositorios, y el motivo más común para no hacerlo fue por carecer de computadora e Internet en el lugar de trabajo (62,4 por ciento). El 76,8 por ciento consideró que sus necesidades de información estaban insatisfechas con los recursos y servicios proporcionados por el hospital. El estado actual de la gestión de la información de los médicos entrevistados pone en riesgo su actualización profesional, disminuye la posibilidad de prescribir tratamientos racionales y de tomar decisiones eficientes(AU)


The purpose of the study was to identify the information needs about drugs and public health among doctors from a Mexican hospital. A descriptive cross-sectional analysis was conducted in the year 2016 which was based on an expert validated survey and a pilot study of 112 doctors. Participants were selected by simple random sampling at a secondary hospital in Nayarit, Mexico. The variables analyzed were information needs, information behavior and satisfaction level. Of the doctors surveyed, 66.4 percent needed information related to the drug treatment of their patients, whereas 63.3 percent needed population data. Medical journals were the favorite source of information (70.4 percent) and obtained the highest satisfaction score. 89.5 percent of respondents did not consult any database or repository, and the most common reason was they did not have a computer with Internet access at the workplace (62.4 percent). 76.8 percent considered that their information needs were not satisfied by the resources and services available at the hospital. The current information management status of the doctors interviewed poses a risk to their professional updating, reducing the possibility of prescribing rational treatments and taking efficient decisions(AU)


Subject(s)
Humans , Male , Female , Pharmaceutical Preparations , Evidence-Based Medicine/methods , Information Management/methods , Access to Information , Periodicals as Topic , Epidemiology, Descriptive , Cross-Sectional Studies
8.
Rev. bras. oftalmol ; 78(6): 413-417, nov.-dez. 2019. graf
Article in English | LILACS | ID: biblio-1057912

ABSTRACT

Abstract Facing an enormous influx of information from medical research, clinicians need to differentiate robust study findings from spurious ones. The levels of evidence are an important component of Evidence-Based Medicine. Understanding the levels helps the Ophthalmologist to prioritize information and make right clinical decisions. The aim of this article is to describe the hierarchy of studies regarding their scientific evidence focusing on ophthalmology.


Resumo Em face a um enorme influxo de informações de pesquisa médica, os clínicos precisam diferenciar os achados de estudos robusto dos espúrios. Os níveis de evidência são um componente importante da Medicina Baseada em Evidências. Compreender os níveis ajuda ooftalmologista a priorizar as informações e tomar decisões clínicas corretas. O objetivo deste artigo é descrever a hierarquia dosestudos em relação à evidência científica com enfoque na oftalmologia.


Subject(s)
Evidence-Based Medicine/methods , Clinical Decision-Making , Ophthalmologists , Ophthalmology/trends , Research Design/standards , Knowledge , Biomedical Research
9.
Rev. Soc. Cardiol. Estado de Säo Paulo ; 29(3): 261-267, jul.-set. 2019. ilus
Article in English, Portuguese | LILACS | ID: biblio-1023048

ABSTRACT

Os três estudos que tiveram importante influência na prática clínica de quem trabalha com hipertensão arterial foram os estudos SIMPLICITY HTN-3, PATHWAY 2 e SPRINT. O estudo SIMPLICITY HTN-3 pôs a dúvida um procedimento que já estava sendo utilizado na prática clínica, qual seja, denervação do nervo simpático renal através de ablação por ondas de radiofrequência. Foi o primeiro estudos com grupo controle que não mostrou diferença entre os desfechos específicos de controle da pressão arterial em pacientes com hipertensão resistente. Portanto, o estudo SIMPLICITY HTN 3 modificou a prática clínica no sentido de que todas as diretrizes de hipertensão são unânimes em afirmar que tal procedimento atualmente deva ser reservado para laboratórios específicos de investigação clínica do método e não deve ser empregado como opção estabelecida de tratamento. O estudo PATHWAY 2 consolida o uso do bloqueador de receptor de mineralocorticoides (espironolactona) como o quarto medicamento no fluxograma de tratamento da hipertensão arterial resistente. Os resultados foram tão impactantes que a diretriz europeia de hipertensão arterial mudou substancialmente a orientação da sequência farmacológica do tratamento. Por fim, o estudo SPRINT demonstrou a necessidade de intervenção em pacientes com hipertensão arterial com valores pressóricos abaixo de 140/90 mmHg na dependência da quantidade de risco adicional dos pacientes. Os resultados do estudo SPRINT motivaram alterações ou inclusões de seus dados em várias diretrizes nacionais e internacionais, tais como Sociedade Brasileira de Cardiologia, American Heart Association e European Society of Cardiology


The three studies that have had an important influence on the clinical practice of who works with arterial hypertension were the SIMPLICITY HTN-3, PATHWAY 2 and SPRINT studies. The SIMPLICITY HTN-3 study raised doubts around a procedure that was already being used in clinical practice, the denervation of the sympathetic renal nerve through radiofrequency wave ablation. It was the first study with a control group that did not show a difference between the specific blood pressure control outcomes in patients with resistant hypertension. Therefore, the Simplicity HTN 3 Study modified clinical practice in the sense that all hypertension guidelines are unanimous in stating that currently such a procedure should be reserved for specific clinical investigation laboratories researching the method and should not be used as an established treatment option. The PATHWAY2 study consolidated the use of the mineralocorticoid receptor blocker (spironolactone) as the fourth drug in the resistant arterial hypertension treatment flowchart. The results were so impactful that the European guideline for arterial hypertension changed its orientation around the pharmacological sequence of resistant hypertension treatment substantially. Finally, the SPRINT study demonstrated the need for intervention in patients with arterial hypertension with pressure values below 140/90 mmHg, depending on the amount of additional cardiovascular risk in those patients. The results of the SPRINT study promoted changes to or inclusions of its data in various national and international guidelines, such as the Brazilian Society of Cardiology, the American Heart Association and the European Society of Cardiology


Subject(s)
Humans , Male , Female , Evidence-Based Practice/methods , Hypertension/therapy , Spironolactone , Guidelines as Topic/standards , Doxazosin , Bisoprolol , Blood Pressure Monitoring, Ambulatory/methods , Evidence-Based Medicine/methods , Arterial Pressure , Antihypertensive Agents
10.
Rev. cuba. ortop. traumatol ; 33(1)ene.-jun. 2019. graf, tab
Article in Spanish | LILACS, CUMED | ID: biblio-1101658

ABSTRACT

Introducción: La restauración de las fuerzas biomecánicas a través del ajuste del offset y la longitud de miembros se ha convertido en un objetivo importante cuando el cirujano busca un buen resultado funcional postoperatorio. Sin embargo, las ventajas clínicas de la restauración del offset femoral y las complicaciones del fallo en la restauración no han sido claramente establecidas. Objetivo: Evaluar el efecto del offset o voladizo femoral en los resultados clínicos y funcionales de los pacientes. Adquisición de la evidencia: Se realizó una exploración en la base de datos Pubmed, con las palabras clave: artroplastia de cadera, prótesis de cadera, resultado clínico y resultado funcional.Se buscaron artículos publicados entre 2008 y 2018, basados en humanos y escritos en inglés, español o francés. Se seleccionaron seis artículos que incluían la presencia de una medición radiológica del offset femoral claramente explicada, escalas validadas y análisis comparativo. Resultados: La literatura consultada reflejó resultados heterogéneos. En el grupo de pacientes con offset disminuido, un artículo mostró menos función. En otro estudio se observó mejor puntuación en el grupo de enfermos con offset aumentado. A su vez, en una investigación se comprobó menos dolor en el grupo de offset disminuido. Conclusiones: Debido a la inconsistencia en los resultados y en las metodologías empleadas, no ha sido posible reconocer el beneficio clínico y funcional de la restauración del offset. Algunos autores incluidos en esta revisión, después de no encontrar diferencias estadísticamente significativas, afirmaron que la restauración o el aumento del offset femoral aportó buenos resultados, sin efectos negativos(AU)


Introduction: The restoration of biomechanical forces through offset adjustment and limb length has become an important objective when the surgeon seeks a good postoperative functional result. However, the clinical advantages of femoral offset restoration and complications of restoration failure have not been clearly established. Objective: To evaluate the effect of offset or femoral cantilever on the clinical and functional results of the patients. Acquisition of evidence: An exploration was carried out in the Pubmed database, with the keywords: hip arthroplasty, hip prosthesis, clinical result and functional result. We searched for articles published from 2008 to 2018, based on humans and written in English, Spanish or French. Six articles were selected because they clearly explained the presence of a radiological measurement of the femoral offset, including validated scales and comparative analysis. Results: The literature consulted reflected heterogeneous results. In the group of patients with decreased offset, one article showed less function. In another study, a better score was observed in the group of patients with increased offset. In turn, one investigation reported less pain was found in the reduced offset group. Conclusions: Due to the inconsistency in the results and the methodologies used, it has not been possible to recognize the clinical and functional benefit of offset restoration. Some authors included in this review, after not finding statistically significant differences, stated that the restoration or increase of the femoral offset provided good results, without negative effects(AU)


Subject(s)
Humans , Male , Female , Evidence-Based Medicine/methods , Arthroplasty, Replacement, Hip/methods , Hip Prosthesis , Spain , Treatment Outcome
11.
Rev. cuba. med ; 58(1): e978, ene.-mar. 2019.
Article in Spanish | LILACS, CUMED | ID: biblio-1093597

ABSTRACT

La medicina basada en la evidencia nace como paradigma a la práctica previa de la medicina que tenía como pilares el razonamiento fisiopatológico de la enfermedad y la experiencia del médico. Con el objetivo de actualizar los conocimientos de la medicina basada en la evidencia en relación con el método clínico, se realizó una revisión bibliográfica descriptiva de 29 artículos relacionados con el tema. Se referenciaron 13 artículos de los últimos cinco años publicados en revistas de los grupos 1 y 2, empleando las bases de datos SciELO, Medline, Pubmed e Hinari y Google Académico. Se concluyó que la medicina basada en la evidencia parte de evaluar críticamente la literatura científica, de modo que se pueda extrapolar los resultados investigativos en la construcción del conocimiento, es decir, acortar la brecha entre la investigación y la práctica clínica(AU)


Evidence-based medicine arose as a paradigm to the previous practice of medicine that had the pathophysiological reasoning of the disease and the doctor's experience as pillars. In order to update the knowledge of evidence-based medicine in relation to the clinical method, a descriptive bibliographic review of 29 articles related to the subject was carried out. 13 articles published in the last five years in journals of groups 1 and 2 were referenced, using SciELO, Medline, Pubmed, Hinari and Google Scholar databases. It was concluded that evidence-based medicine starts from critically evaluating scientific literature, so that research results can be reasoned in the construction of knowledge, that is, shortening the gap between research and clinical practice(AU)


Subject(s)
Humans , Evidence-Based Medicine/methods , Evidence-Based Practice/methods
12.
Interface (Botucatu, Online) ; 23: e170566, 2019. graf
Article in Portuguese | LILACS | ID: biblio-1002348

ABSTRACT

As políticas públicas baseadas em evidências precisam responder às vulnerabilidades sociais na superação das iniquidades. A presente revisão de literatura, do tipo narrativa, analisa os desafios de adaptação na difusão de práticas de prevenção ao uso de álcool e outras drogas baseadas em evidências no Brasil. As teorias de Difusão de Inovações (Rogers) e de Implementação de práticas baseadas em evidências (Aarons et al.) embasaram a crítica aos modelos existentes. Conclui-se que a implantação de uma ação preventiva baseada em evidências, mas que não é culturalmente relevante, corre o risco de não incidir nas vulnerabilidades. Ao mesmo tempo, as adaptações, mesmo que promovam altos níveis de aceitabilidade, podem comprometer a efetividade do programa caso sejam realizadas sem o embasamento em evidências e podem descaracterizar a inovação, passando a servir na reprodução de iniquidades, as quais a inovação compromete-se a mudar.(AU)


Las políticas públicas basadas en evidencias necesitan responder a las vulnerabilidades sociales en la superación de las iniquidades. La presente revisión de la literatura, del tipo narrativa, analiza los desafíos de adaptación en la difusión de prácticas de prevención al uso del alcohol y otras drogas basadas en evidencias en Brasil. Las teorías de "Difusión de innovaciones" (Rogers) y de "Implementación de práctica basada en evidencia" (Aarons et al.) sirvieron de base a la crítica a los modelos existentes. Se concluye que la implantación de una acción preventiva con base en evidencias, pero que no es culturalmente relevante, corre el riesgo de no incidir en las vulnerabilidades. Al mismo tiempo, las adaptaciones, aunque promueven altos niveles de aceptabilidad, pueden comprometer la efectividad del programa caso se realicen sin base en evidencias y pueden desvirtuar la innovación pasando a servir en la reproducción de iniquidades que la innovación se compromete a cambiar.(AU)


The evidence-based public policies need to address the social vulnerabilities in order to overcome the inequities. This narrative literature review analyzes the challenges of adaptation in the dissemination of the evidence-based alcohol and drugs prevention practices within the context of the Brazilian public policies. The critique of existing models is based on the theories of "Diffusion of Innovations" (Rogers) and "Implementation of the evidence-based practices" (Aarons et al). We concluded that the implantation of an evidence-based preventive action, if culturally not relevant, risks not impacting on the vulnerabilities. The adaptations may promote higher levels of acceptance and adhesion. In spite of that, if those adaptations are performed without the evidence base, they may reduce the effectiveness, as well as de-characterize the innovation, ending up in the reproduction of the inequities it aimed to reduce.(AU)


Subject(s)
Public Policy , Evidence-Based Medicine/methods , Alcoholism/prevention & control , Brazil
15.
Rev. Soc. Cardiol. Estado de Säo Paulo ; 28(3 (supl)): 365-371, jul.-set. 2018. tab
Article in English, Portuguese | LILACS | ID: biblio-964476

ABSTRACT

As formas agudas de hipertensão arterial constituem-se nas crises hipertensivas (CH), as quais representam uma causa frequente de emergência e consultas de atenção primária. O presente estudo teve como objetivo analisar as evidências científicas sobre os cuidados de enfermagem em CH publicadas na literatura nos últimos 10 anos. Trata-se de uma revisão integrativa desenvolvida a partir das etapas propostas pela literatura. Foram utilizadas as bases de dados Public Medline ou Publisher Medline (PubMed), Literatura Latino-Americana e do Caribe em Ciências da Saúde (LILACS) e Scientific Electronic Library Online (SCIELO) e selecionados os artigos publicados entre 2008 e 2018. Foram encontrados 10 artigos, sendo 40% deles nacionais, 50% dos Estados Unidos e 10% do México. Os achados apontam que os cuidados de enfermagem com o paciente em crise hipertensiva se referem à abordagem inicial do paciente em sala de emergência, avaliação inicial, intervenções da enfermagem relacionadas aos cuidados emergenciais, educação em saúde e medida de pressão arterial. É necessária a realização de estudos que abordem a atuação do enfermeiro frente aos cuidados prestados em CH, a fim de construir evidências para garantir a melhor forma de avaliar o cliente, identificar os diagnósticos de enfermagem para, então, propor intervenções eficazes


Acute forms of hypertension constitute hypertensive crises (HC), which represent a frequent cause of emergency and primary care consultations. This study aims to analyze scientific evidence relating to nursing care in HC published in the literature in the last ten years. This is an integrative review developed based on the stages proposed in the literature. The databases used were Public Medline or Publisher Medline (PubMed), Latin American and Caribbean Health Sciences Literature (LILACS) and Scientific Electronic Library Online (SCIELO), selecting articles published between 2008 and 2018. Ten articles were found; 40% from Brazil, 50% from the United States and 10% from Mexico. The findings indicate that the nursing care of patients in hypertensive crisis relate to the initial approach to the patient in the emergency room, initial evaluation, nursing interventions related to emergency care, health education and blood pressure measurement. Studies are needed that address nurses' actions in relation to HC care, in order to construct evidence to ensure the best form of evaluating the client, identify the nursing diagnoses, and then propose effective interventions


Subject(s)
Humans , Male , Female , Emergencies , Hypertension/complications , Nursing Care/methods , Patient Care Team , Therapeutics , Evidence-Based Medicine/methods , Emergency Medicine/methods , Emergency Treatment/methods
18.
Rev. saúde pública (Online) ; 52: 57, 2018. tab, graf
Article in English | LILACS | ID: biblio-903435

ABSTRACT

ABSTRACT OBJECTIVE: To verify whether an intervention based on disseminating health evidence summaries by e-mail to health professionals increases access to health evidence databases, and whether health professionals intend to apply the evidence received by e-mail in their clinical practice. METHODS: This quantitative study started with a survey to collect demographic data and patterns of access to health evidence databases. It was followed by a longitudinal intervention, over 48 weeks, that disseminated 143 health evidence summaries to 339 health professionals with higher education degree who work in the Brazilian Unified Health System. In the longitudinal intervention phase, health professionals voluntarily assessed the received health evidence summaries using the information assessment method. Finally, the study concluded with a survey to identify changes in accessing health evidence databases. RESULTS: Of the 339 Brazilian health professionals participating in this research, 90 (26.5%) answered the initial and final surveys. After 48 weeks, there was an increase in the use of health evidence databases; 186 (54.9%) participants submitted 7,942 assessments of health evidence summaries, which were relevant for patient care in 5,409 (68%) assessments. CONCLUSIONS: The dissemination of health evidence summaries by e-mail to health professionals in Brazil increases the reported use of evidence in clinical practice.


Subject(s)
Humans , Male , Female , Adolescent , Adult , Young Adult , Health Personnel/education , Evidence-Based Medicine/methods , Electronic Mail , Medical Informatics Applications , Brazil , Longitudinal Studies , Health Personnel/classification , Public Health Informatics , Middle Aged , National Health Programs
20.
Medicina (B.Aires) ; 76(2): 71-75, abr. 2016. ilus, tab
Article in Spanish | LILACS | ID: biblio-841545

ABSTRACT

Para evaluar la confiabilidad y precisión de la información médica proporcionada por los medios de comunicación en Argentina, alumnos avanzados de medicina, que desconocían los objetivos del estudio, identificaron aseveraciones relacionadas a temas médicos transmitidas por medios de comunicación. Los hallazgos fueron contrastados con recomendaciones realizadas por médicos expertos en la toma de decisiones basada en evidencias. Las recomendaciones de los medios y las confeccionadas por los expertos fueron comparadas en relación a su fuerza y dirección. Se identificaron 81 recomendaciones/preguntas las que fueron contestadas por los expertos, 15 con alta, 18 con moderada, 30 con baja y 18 con muy baja calidad de evidencia. Solamente el 53% (IC95% 42-64%) de las recomendaciones hechas por los medios de comunicación coincidieron en la dirección (a favor o en contra de la intervención) con las realizadas por los expertos y el 28% (IC95% 18-39%) fueron calificadas como inadecuadas (diferencias significativas tanto en dirección como en fuerza). El análisis del subgrupo de recomendaciones realizadas en los medios por profesionales de la salud mostró una coincidencia en la dirección del 71% (IC95% 56-86%) con 17% (IC95% 6-33%) de recomendaciones inadecuadas, OR = 0.35 (IC95% 0.1-1.1) en relación a las no realizadas por profesionales de la salud. Se concluye que la información médica que proveen los medios de comunicación en Argentina es poco confiable, lo que posiblemente tenga un impacto negativo sobre el funcionamiento del sistema de salud y la relación de los médicos con sus pacientes.


To evaluate the certainty and accuracy of the healthcare information provided by the mass media in Argentina, a group of senior medical students, blind to the study objectives, identified healthcare related statements transmitted through mass media. These findings were challenged against the recommendations of a group of physicians trained in evidence-based decision making (EBDM). We compared the strength and direction of the mass media recommendations with those of experts on EBDM. Eighty one recommendations/questions were identified and answered by the experts on EBDM, 15 with high, 18 with moderate, 30 with low and 18 with very low quality of evidence. Only 53% (CI95% 42-64%) of the mass media recommendations agreed with the expert recommendation in direction (for or against) and 28% (CI95% 18-39%) were classified as inappropriate (significant discrepancies both in direction and strength). Subgroup analysis revealed that 71% (CI95% 56-86%) of there commendations made by professionals in mass media agreed with experts in direction and 17% (IC95% 6-33%) were classified as inappropriate, OR = 0.35 (CI95% 0.1-1.1) compared to recommendations in mass media by non-professionals. We conclude that the healthcare information provided by mass media in Argentina is unreliable; this fact can probably have a negative impact in the health system performance and physician-patient relationship.


Subject(s)
Humans , Patient Education as Topic/standards , Evidence-Based Medicine/standards , Trust , Consumer Health Information/standards , Mass Media/standards , Medical Staff, Hospital/standards , Argentina , Students, Medical , Patient Education as Topic/statistics & numerical data , Cross-Sectional Studies , Evidence-Based Medicine/methods , Decision Making , Medical Staff, Hospital/statistics & numerical data
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